Individual
MS. MARY BAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LADC, MFT INTERN
Contact information
Practice address
110 1ST ST E STE 102, JORDAN, MN 55352-1502
(651) 356-5234
Mailing address
7997 147TH ST W, APPLE VALLEY, MN 55124-6347
(651) 356-5234
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033529664
MENTAL HEALTH AND SUBSTANC E ABUSE
MN
05
—
1033529664
—
MN
Enumeration date
05/05/2014
Last updated
01/22/2020
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